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2. Pursuant to the City of Waukegan Ordinance # 11-O-28
4. Return for the Month of: *
   -- Select One --JanuaryFebruary MarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1st Quarter2nd Quarter3rd Quarter4th QuarterAnnual
5. Return for the Year of: *
   -- Select One --20302029202820272026202520242023202220212020201920182017
7. Name of Business*
9. Business Address*
11. 1. Gross Receipts*
    Enter the total sale of prepared food and alcoholic beverages exclusive of all taxes
13. 2. Deductions
14. 2.a Deductions List
    Provide detailed Deductions List if deductions are listed.
15. 3. Taxable Amount*
    Subtract Gross Receipts from Deductions. Line 1 - Line 2. Example: 1000-25 = 975
17. 4. Total Tax Due*
    Line 3 x 1%
19. 5. Late Fee*
    If filed after the due date (general the 20th of the month following collections)...add 5% Penalty (Line 4 x 5%)
21. 6. Total Amount Due to the City*
    Line 4 + Line 5
23. ST-1 Form Required
    In order to complete this form online, Form ST-1 (State Tax Return) must be attached as a PDF below.
24. Attach ST-1 Form*
    Please attach copy of State of IL ST-1 Form
26. Attach any additional forms

    Please attach any forms with further tax return information

28. *Tax is due on or before the 20th of the month after incurrence, i.e., January returns and tax remittance is due on or before February 20th.
30. Failure to accurately and timely report and remit Food & Beverage Tax may result in penalties, including, but not limited to, fines and legal proceedings.
32. I hereby affirm that the statements herein contained are true and correct to the best of my knowledge and belief.
34. Signature of Authorized Official*
35. Print Name & Title of Official*
39. Print Name & Title of Tax Preparer*
40. Telephone Number of Tax Preparer*
42. Mailing Address of Tax Preprarer*
44. Tax Payer E-Mail*
46. Tax payment will be remitted via:*

    1. Mail - Send to the City of Waukegan
    2. In person
    3. Epay

    Select one method of payment
47. The City of Waukegan
    ATTN: Licensing Department 100 N. Martin Luther King Jr. Ave Waukegan, IL 60085 Telephone# 847-856-6425 Fax# 847-599-2584
48. Online Payment
    E-Pay

    Link will open new window for online payment but will not submit this form. Hit the below 'Submit' button to send e-file.
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field